JR's Orchards Registration Form for New Zealand Residents.

    Section 1: Personal Details

    Compulsory.
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    Section 2: Citizenship / Permanent Residence Status

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    Section 3: Criminal Convictions

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    Section 4: Medical Details

    Back Trouble or Limb Injury?
    Hand or Wrist Pain?
    Deafness or Hearing Problems?
    Frequent Headaches?
    Persistent Cough, Bronchitis or Asthma?
    Do you wear glasses?
    Colour Blindness or blurred vision?
    Any Allergies or Hay Fever?
    Dermatitis or Eczema?
    Heart trouble or High blood pressure?
    Diabetes, Tuberculosis or Hepatitis?
    Blackouts or Epilepsy?
    Do you have any contagious diseases?
    Measles, Mumps, Chicken Pox, HIV/AIDS, hepatitis, TB, food poisoning?
    Do you have any outstanding ACC or medical claim(s)?
    Are you on any form of prescribed medication?
    Please enter one response per row
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    Section 5: Education

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    First Aid Certificate?
    Current Forklift License?
    Growsafe Certificate?
    Current drivers license?
    Please enter one response per row

    Section 6: Work Experience

    In the next five areas please provide information about previous employment. If a school leaver, list after school and holiday work. 1. Please Give Dates of employment. 2. Employers Name. 3. Duties. 4. Reason for leaving.
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    Hydralada work
    Tractor driving
    Bench grafting
    Packhouse work
    Viticulture vine work
    Nursery work
    Weeding
    Fruit picking
    Apple thinning
    Apple pruning
    Forklift work
    Grape pruning
    Planting
    Hoeing
    Please enter one response per row

    List up to three referees.

    (NB: Previous employer are the best source of references)
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    Declaration

    The above declarations are true and honest. I give JR's Orchards Ltd permission to pass on my personal details given on this form to any prospective Employer or relevant Government agency for the purpose of employment. I consent to JR's Orchards Ltd or a prospective employer seeing verbal and written information on a confidential basis about me from my previous employers and Work and Income and authorise the information sought to be released by them to JR's Orchards Ltd for the purpose of ascertaining my suitability for any position I am applying for.
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